Redefining the R1 resection for pancreatic ductal adenocarcinoma: tumour lymph nodal burden and lymph node ratio are the only prognostic factors associated with survival

Abstract

LNB and LNR are the only prognostic factors for CSS in patients with pancreatic head adenocarcinoma, but do not predict recurrence. Microscopic RMs does not seem to influence the outcome even when redefined. Further prospective studies are indicated to substantiate these findings.

A systematic review of the prognostic value of lymph node ratio, number of positive nodes and total nodes examined in pancreatic ductal adenocarcinoma

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] There were 5 prospective studies, 1 randomised controlled trial and 13 retrospective studies (Table 1). All included studies analysed survival using the Kaplan-Meier method, defining an event as the death of a patient and overall survival from the time elapsed from surgery to death.…”

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Association between these subgroups and overall survival was investigated and presented using Kaplan-Meier curves. A high lymph node ratio was associated with decreased overall survival in 17 studies, [13][14][15][16][17][18][19][20][21][22][24][25][26][27][28]30,31 and no association was found in two studies. 23,29 Lymph node ratio was significantly associated with overall survival in most studies.…”

“…14, [16][17][18][19][20][21][22][23][24][25][28][29][30][31] Total nodes examined was not linked with overall survival in 12 studies. 14,[16][17][18][20][21][22][23][24][25]30,31 Only three studies showed that an increase in total nodes examined was associated with improved overall survival.…”

“…14,[16][17][18][20][21][22][23][24][25]30,31 Only three studies showed that an increase in total nodes examined was associated with improved overall survival. 19,28,29 Total nodes examined was not associated with overall survival in most studies.…”

Surgical techniques for improving outcomes in pancreatic ductal adenocarcinoma

“…Median survival was 15 months (9-23 months) and the authors concluded that in high-volume centers, vascular resection has acceptable morbidity, mortality and survival outcomes and should not be seen as a contraindication to curative surgery. By pooling results from studies reporting resection margin status after PD [8,18,[36][37][38][39][40][41], a positive medial resection margin was reported in 38.2% of 701 patients. However, following PD with PV/SMV resection, the medial resection margin is only positive in 16% of patients, and it is well recognized that an R0 medial resection margin is a predictor of improved survival [8].…”